Multimodal approach to osteoarthritis advocated - Veterinary Practice
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Multimodal approach to osteoarthritis advocated

SOME 600 vets and nurses attended
Excellence in multimodal
osteoarthritis management
CPD events
last October, undertaken in a
collaboration between Pfizer Animal
Health and Hill’s Pet Nutrition,
hearing that the key challenge of
osteoarthritis is how to manage it.

Professors Stuart Carmichael and
John Innes and David Prydie presented
the latest thinking on the disease and
delegates ran through a series of
diagnosis and management exercises
and left with a toolkit of ideas to apply
in practice. Sessions addressed medical
and surgical management of the
osteoarthritic patient as well as
rehabilitation and weight management.

Prof. Carmichael explained why
management of the disease is so
important: “We know osteoarthritis is
very common because we see it all the
time in dogs, yet there is still an
underlying notion that it is a poorly
treated disease.

“This is probably because of the
very nature of the disease. It’s a chronic,
incurable disease which presents when
two different forms – an acute flare and
chronic disease – occur together. It is also worth reminding
ourselves that dogs are
programmed not to
show signs until it has
become chronic, so it is
difficult for owners to

“The underlying
chronic signs tend to go
unnoticed and therefore
unmanaged so vets need
to focus on the chronic
disease element and its
impact and put more
emphasis on the
complexity of the
problem. It is also a lifetime disease
requiring vets to focus on compliance –
the owner needs to come on the
journey to ensure the correct


He continued: “It is the complexity of
the disease that has driven the need for
a multimodal approach. In looking at
the complexity of the pathology, vets
should divide the disease into different
stages (Figure 1).

“The first logical extension of the
disease is outside the joint. That
extension is then
followed by loss of
mobility and then
changes, by which
time even a normal
stimulus becomes a
painful stimulus.
An end-stage joint
will no longer respond to non-
surgical treatment so
this stage needs to be

“How can we use
what we know about
the disease to affect
its management? By
recognising what
stage the disease is at,
vets can assess how
the dog would
respond to different
treatments, bearing in
mind the disease
almost always affects multiple joints so every joint needs to be

“Both clinical and pathological signs
should be used to conduct an appraisal
including structural changes, physical
consequences, pain response and
general information such as the vet’s
background knowledge of the disease,”
he said.”

Using a multimodal management
scheme allows the identification of
treatments that are different in their attack, but also synergistic. By using a
combination of treatments, dependence
on one treatment method is reduced.
Vets can identify which areas are
important by following a six-point plan
to develop a management strategy for
osteoarthritis (Figure 2),” Prof.
Carmichael said.

The speakers demonstrated that by
utilising multiple management options
simultaneously in the treatment of
osteoarthritis, the synergy provides less
dependence on each individual
intervention and helps achieve a better
overall result.

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